Provider Demographics
NPI:1801813332
Name:DEMIROVIC, EMIR (PT)
Entity Type:Individual
Prefix:
First Name:EMIR
Middle Name:
Last Name:DEMIROVIC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5549
Mailing Address - Country:US
Mailing Address - Phone:716-631-8081
Mailing Address - Fax:716-631-8082
Practice Address - Street 1:6301 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1051
Practice Address - Country:US
Practice Address - Phone:716-684-0400
Practice Address - Fax:716-683-7028
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011174501OtherUNIVERA
NY6696846OtherGHI
NMP00293712OtherRR MEDICARE
NY000410409002OtherBC/BS
NY9313038OtherIHA
NY000410409001OtherBC/BS
NYRA8104Medicare ID - Type Unspecified